Adult Oncology Research Articles

Use of molecular residual disease (MRD) testing with measurement of circulating tumor DNA (ctDNA) post-operatively in stage II colon cancer (SIICC) in the community-based setting.

53 Background: 80% of adult oncology patients (pts) are treated in the community-based setting. Data on the implementation of emerging technologies such as ctDNA testing is scant in this population. Use of adjuvant chemotherapy in SIICC pts historically was based on clinical/pathological risk factors however new data presented in mid 2022 utilizes the presence or absence of ctDNA 6-8 weeks post operatively to help risk stratify pts. The absence of ctDNA predicts a high chance of disease-free survival. Use of ctDNA was incorporated into the NCCN Colon Cancer guidelines as of 2023. In a private practice setting, we retrospectively looked at the use of ctDNA assay for adjuvant chemotherapy decision-making in SIICC pts. Methods: We conducted a retrospective study to quantify ctDNA testing frequency in SIICC pts in our community based oncology practice. The historical cohort was comprised of pts diagnosed prior to the NCCN guideline inclusion of ctDNA; the current cohort included pts diagnosed after the NCCN guideline change. For all pts, we reviewed clinicopathologic risk factors deemed to be high risk (positive margin, < 12 LN removed, tumor budding, lymphovascular invasion, poorly differentiated features; perforation or obstruction) and used this for stratification. Low-risk pts had no high risk features. Medical record data (office notes, pathology, molecular testing) was evaluated to determine ctDNA results including timing and use of adjuvant chemotherapy. Primary endpoint was the percent (%) of current pts who were low-risk with ctDNA testing sent compared to historical control. Secondary endpoint was the % of ctDNA testing sent within 8 weeks of curative surgery in both cohorts. Results: In a private practice setting, we identified low-risk SIICC pts spanning a 36-month period and categorized them into two groups: the historic cohort (A) pts were diagnosed between July 2021-Dec 2022, and the active cohort (B) pts were diagnosed between Jan 2023-July 2024. 26 pts were identified in cohort A and 36 pts were identified in cohort B to have SIICC. Out of 26 pts in cohort A, we identified 13 low risk SIICC pts; for cohort B, out of 36 pts, we identified 25 low-risk SIICC pts. The percentage of pts in each group that had ctDNA testing sent was 79.6% (10/13 pts) in cohort A and 92% (23/25 pts) in cohort B. In cohort A, 80% (8/10 pts) and in cohort B, 90.9% (20/22 pts) had ctDNA sent within 8 weeks of surgery. Conclusions: Incorporation of ctDNA testing in low-risk SIICC pts in a community-based setting occurred quickly. As ctDNA testing was implemented into practice, a majority of pts had the testing sent in the appropriate time frame. Future best practices, especially in the community, should incorporate tumor specific clinician oversight with use of updated pathways to ensure any recent changes to standard of care are followed.

Likes and Hashtags: Exploring the Potential Relationship Between Social Media use and the Emotional Wellbeing of Oncology Professionals.

To explore the potential relationship between social media (SoMe) and burnout or overall wellbeing within the field of oncology. A cross-sectional study of adult and pediatric oncology professionals conducted using an anonymous electronic survey. The survey was disseminated through the Children's Oncology Group (COG) and the SWOG Cancer Research Network (SWOG) member listservs. The majority of pediatric and adult oncology professionals are not engaging on, with only 873/3000 (29%) using SoMe professionally. Use of SoMe was associated with statistically significant higher incidence of self-reported burnout and poorer self-reported work‒life integration (WLI). However, both groups reported the same degree of career satisfaction and choosing the same career/job again. SoMe users and non-users reported similar overall psychological distress, although the use of SoMe was associated with less severe psychological distress. While SoMe users reported higher rates of burnout and poorer WLI compared to non-users, it was not accompanied by higher levels of psychological distress. Furthermore, there were no differences in career satisfaction. These misalignments require further study.

Compensatory Swallowing Strategies Recommended in Oncology Practice: Practice Patterns and Relationship to Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) Grades.

Compensatory swallow strategies are recommended to improve swallow safety and efficiency; however, there is limited evidence on use in specific populations or their relationship to swallow study results. We sought to describe/explore strategy recommendations in an oncology practice and their relationship to Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) grades as a marker of clinical utility of the tool. This is a sub-study of a STARI-guided retrospective implementation evaluation at a single comprehensive cancer center. Electronic health record databases were queried to sample all modified barium swallow studies (MBS) for all adult oncology patients from 2016 to 2021, excluding total laryngectomy, leak studies and those with missing DIGEST grades. For patients with multiple MBS studies across the study period, one MBS was randomly selected to be included in the analytic sample. DIGEST grade, diet recommendation, oncologic details, and swallow strategy details were chart abstracted. Strategies and oral intake recommendations were classified from least to most restrictive. This study included 4570 patients representing diverse oncology populations (46% head and neck). DIGEST grades indicating at least mild dysphagia (grades ≥ 1) were reported in 2486 of MBS (54%). Strategies were recommended in 2028 MBS (44%). As DIGEST grade increased so did strategy utilization and complexity (Spearman's r (rS) = 0.76, p < 0.0001). This pattern was consistent for Safety (rS = 0.68) and Efficiency (rS = 0.73) grades (both p < 0.0001). Swallow strategies are frequently recommended in oncology populations. This is the first study to show a systematic link between DIGEST grade and MBS compensatory strategy recommendations, supporting clinical effectiveness of DIGEST as an evidence-based practice tool.

The Outcomes of Pediatric, Adolescent, and Young Adult Oncology Patients With Non-neutropenic Fever: A Scoping Review of the Literature.

There are established and well-followed guidelines for pediatric oncology patients who have neutropenic fever. However, there are no explicit criteria for this patient group, and over 50% of pediatric oncology patients with fever do not present with neutropenia. In this scoping review, we have explored the outcomes of non-neutropenic fever in pediatric, adolescent, and young adult patients with cancer-directed treatment. The results of this scoping review should assist in the creation of a guideline for the management of non-neutropenic fever in this group of patients. Multiple electronic databases and reference lists were searched (PubMed, MEDLINE CENTRAL, and Google (first 100 results only)). Included are retrospective and prospective cohort studies on the management and outcome of pediatric oncology patients with non-neutropenic fever that have been published after the year 2000. Seventeen studies with a total of 10.845 fever episodes were included, that address the treatment and outcome of patients with non-neutropenic fever. The rate of bacteremia was 1.6 - 14.4% (mean 5.8%). The mortality rate was low due to non-bacterial causes. Across different studies, proposed risk factors for bacteremia were higher temperature, prolonged fever over 72 hours, ill-appearing patients, chills, hypotension, leukocytosis, infancy, and the presence of a Broivac/ Hickman catheter. Limitations to this study are the risk of bias, and potential incomplete identification of relevant studies pertinent to the research questions asked. Due to significant heterogeneity, the published data so far are not sufficient to propose evidence-based guidelines for pediatric oncology patients with non-neutropenic fever. Prospective, multicenter registries based on uniform definitions are needed. No funding was received for this manuscript.

Accelerating the Future of Oncology Drug Development: The Role of Consortia in the Delivery of Precision Oncology Early Phase Clinical Trials.

Over the past 15 years, the landscape of early phase clinical trials (EPCTs) has undergone a remarkable expansion in both quantity and intricacy. The proliferation of sites, trials, sponsors, and contract research organizations has surged exponentially, marking a significant shift in research conduct. However, EPCT operations suffer from numerous inefficiencies, such as cumbersome start-up processes, which are particularly critical when drug safety and the recommended phase II dose need to be established in a timely manner. Networks and consortia may overcome some of these challenges of enrolling suitable patients and streamlining start-up, particularly when distance and disease trajectory come into play. In this article, we provide an overview of EPCT consortia in adult oncology across different continents assembled through systematic review of the literature and snowball sampling methodology. We illustrate their scope, structure, funding, and achievements. Fifteen EPCT consortia were identified including two in the United States, three in Europe, five in Asia-Pacific, two intercontinental consortia, and three within private oncology networks. These consortia vary in their scope, funding, and structure from government-funded models such as the National Cancer Institute Experimental Therapeutics Clinical Trials Networks through charitably funded and private research organizations. EPCT consortia play a role in collaborative research, molecular tumor boards to provide patient-centric biomarker-matched treatments, and streamlining trial conduct to improve timelines and cost efficiency. The growth in EPCT activity and complexity has resulted in expansion in the number of EPCT consortia globally. By actively engaging with regulatory bodies and pharmaceutical and contract research organization industries, consortia have an opportunity to address the evolving challenges faced in this field and to accelerate the translation of scientific discoveries into clinical practice.

Stem cell status and prognostic applications of cuproptosis-associated lncRNAs in acute myeloid leukemia.

Acute myeloid leukemia (AML), a highly heterogeneous hematological malignancy, remains a major challenge in adult oncology. Stem cell research has highlighted the crucial role of long noncoding RNA (lncRNA) in regulating cellular differentiation and self-renewal processes, which are pivotal in AML pathogenesis and therapy resistance. This study explores the relationship between cuproptosis-related lncRNAs and AML prognosis, providing novel insights into their impact on hematopoietic stem and progenitor cells. We collected clinical information from 214 AML patients in our center and analyzed the association between granulocyte recovery after chemotherapy, cuproptosis, and prognosis. Additionally, we developed a prognostic model-the cuproptosis-associated long noncoding RNA prognostic model (CRLPM)-y analyzing data from The Cancer Genome Atlas (TCGA). Patients were stratified into high- and low-risk groups based on CRLPM, revealing significant survival differences. High-risk patients demonstrated lower sensitivity to chemotherapeutic agents such as Axitinib, GSK429286A, Navitoclax, and ZM-447439, underscoring the need for alternative therapeutic strategies. CRLPM offers a promising framework for integrating stem cell-focused approaches into personalized treatment regimens, paving the way for precision medicine in AML management.

Perceptions and satisfaction of oncology pharmacy services among cancer patients and healthcare providers at the central zone hospital's oncology section.

Our research focused on assessing the satisfaction of cancer patients with oncology pharmacy services, as well as evaluating the satisfaction levels of other healthcare and supportive staff associated with the oncology pharmacy unit. This qualitative cross-sectional study, based on a questionnaire, aimed to evaluate the best practices of oncology pharmacy services for patients and the efficiency of services provided by healthcare professionals and administrators at Benjamin Mkapa Hospital (BMH). The study was conducted at the adult oncology unit from July to August 2022. It included all consenting patients and staff who attended or served in the unit and met the inclusion criteria during this period. A total of 62 cancer patients and 53 BMH staff members working closely with the unit were interviewed. Among the patients, approximately 86% expressed satisfaction with the overall care provided by the oncology pharmacy services, 79% were satisfied with the dispensing practices and pharmaceutical care, and 64% were pleased with the patient-pharmacy personnel relationship. The staff survey, conducted among those closely collaborating with the oncology pharmacy unit, revealed that 85% were satisfied with the unit's plan and mission, 72% were content with the teamwork and motivation of the pharmacy personnel, and 92% were satisfied with the competencies of the oncology pharmacy staff. Our thorough study revealed notably high levels of satisfaction and acceptance concerning the services provided by oncology pharmaceutical personnel. Pharmacists should ensure their presence during patient visits and dedicate adequate time for counselling to enhance patients' therapeutic alliance. Furthermore, optimising pharmacy workflow and adopting a patient-centred approach will help create a more organised and welcoming environment, reducing turnaround time.

Survival Outcomes Following Chemotherapy for High-Grade Central Nervous System Tumors in Adolescents and Young Adults: An Exploration of Variations According to Ethnicity and Deprivation.

Introduction: Adolescents and young adults (AYA) are a unique subgroup of patients who experience cancer at the interface between pediatric and adult oncology services. Central nervous system (CNS) tumors are the leading cause of cancer-related morbidity and mortality in this group. Socioeconomic status and ethnicity are known to impact CNS tumor survival in patients of all ages. Studies reporting AYA CNS survival outcomes by ethnicity and area-based deprivation, however, are lacking in the United Kingdom (UK). Methods: Using cancer registration data for 351 patients (12-29 years) who received systemic chemotherapy for a high-grade malignant CNS tumor in England between April 2014 and December 2018, we quantified differences in survival at 1, 2, and 3 years post-diagnosis by ethnicity and area-based socioeconomic status. Results: Lower survival estimates were seen for non-White ethnicity and lower socioeconomic groups. Three-year survival was 64.4% (95% CI 58.3-69.9) for White patients but 46.6% (95% CI 29.9-61.7) for non-Whites and 64.0% (95% confidence interval [CI]49.0-75.7) and 62.9% (95% CI 50.7-72.8) in those from the two least deprived fifths compared to 50.2% (95% CI 36.1-62.7) and 56.1% (95% CI 42.4-67.7) in the two most deprived groups. Conclusion: Our study is the first to show the existence of health disparities in AYA treated with chemotherapy for a primary CNS tumor in England, where patients from ethnic minorities and deprived areas had worse survival rates than their White and socioeconomically advantaged counterparts. These findings call for further research into the underlying reasons behind survival differences between sociodemographic groups to improve survivorship outcomes.

Statistical Fragility of Findings From Randomized Phase 3 Trials in Pediatric Oncology.

The fragility index (FI) is an adjunctive metric to facilitate the interpretation of p-values in clinical trials. The FI has not been studied in phase 3 trials in pediatric oncology. PubMed was used to identify phase 3 pediatric oncology trials published between 1980 and 2020. We report trial characteristics and calculate the FI for trials with a binary outcome and survival-inferred fragility index (SIFI) for trials with a time-to-event outcome. FI/SIFI is the number of patients from one arm of a trial who would need to change groups for the statistical conclusion to change. We also report fragility quotients (FQ and SFQ) to normalize FI and SIFI relative to trial size. One hundred and thirteen trials included sufficient data for analysis. The median FI for trials with a binary outcome (n = 40) was 4.5 (range: 1-33). The median SIFI for trials with a time-to-event outcome (n = 73) was 13 (range: 0-61). The FI or SIFI was less than the number of patients lost to follow-up in 25% of 36 trials. Median FQ and SFQ were 0.026 and 0.03, respectively, and did not significantly vary according to trial characteristics. While sample sizes increased over time, the FQ and SFQ remained stable. The statistical conclusions of pediatric oncology phase 3 trials hinge on a relatively small number and proportion of patients. Despite the sample size limitations of low prevalence diseases, pediatric cancer trials are similarly or less fragile than adult oncology trials. Smaller trials do not appear more statistically fragile than larger trials. Statistical fragility appears to have remained constant over the four decades evaluated. We recommend reporting FI or SIFI, in conjunction with p-values, for all phase 3 pediatric oncology trials.

Designing a Measure of Body Image: Cognitive Interview Findings from an Adolescent and Young Adult Cancer Sample.

Purpose: A cancer diagnosis in adolescence and young adulthood significantly impacts a person's quality of life, particularly concerning identity, self-esteem, and subsequently, body image. This study aims to develop a psychometrically-sound patient-reported outcome measure of body image for adolescent and young adult (AYA) oncology patients that was guided by the National Institutes of Health's Patient-Reported Outcomes Measurement Information System® (PROMIS) Scientific Standards and our past concept elicitation interviews with AYAs. Methods: We conducted a multi-step approach involving item identification, refinement, generation; translatability and reading level review; and cognitive interviews. A purposive sample of 25 AYA patients participated, ensuring representation across educational levels, gender, treatment status, and cancer type. Results: Translatability and reading level reviews facilitated language adjustments. Cognitive interviews revealed that 76% of AYAs found the 50 candidate items assessing body image concerns to be easy to answer. AYAs reported that the body image items captured their lived experiences. Three items were excluded due to comprehension difficulties. Conclusion: This study addresses the critical gap in validated measures for assessing body image in AYA oncology patients. Interview findings provided evidence for the content validity and comprehensibility for 47 items assessing body image. The next steps involve large-scale psychometric testing to evaluate the reliability and validity of the body image items to form an item bank allowing the design of short forms or use of computerized-adaptive testing. Ultimately, this work lays the foundation for developing interventions to mitigate the impact of cancer on AYAs' body image during diagnosis, treatment, and recovery.

Abstract 4136498: Analysis of Cardiovascular Events in Cancer Survivors: A Comparative Study of Solid Tumors and Hematologic Malignancies at a Tertiary Cardiovascular Center

Background: Cardiovascular disease (CVD) and cancer represent the leading contributors of death worldwide. Although advancements in antineoplastic therapies have notably enhanced prognoses, CVD now emerges as the primary cause of mortality in this population. Ojective: To assess the occurrence of CVD in cancer survivors and investigate disparities based on their previous cancer diagnosis, categorized into solid tumors or hematological malignancies. Methods: A cross-sectional study was conducted, including adult oncology survivors who had previously undergone oncological treatment and were referred to our center between 2010 and 2023 due to the presentation of major adverse cardiovascular events (MACE). They were categorized into two groups: those with hematological cancer and those with solid tumors. We used Chi2 test to assess differences between categorical variables and the Wilcoxon rank-sum test to evaluate differences in continuous parameters. Statistical analysis was performed using R 4.0 and StataMP 14.1. Results: A total of 214 oncological patients were included (median age: 69 [IQR: 55-80], women: 53%), comprising 164 (76.6%) with solid tumors and 50 (23.4%) with hematological cancer. Baseline characteristics were mostly similar between the groups (Table 1), with diabetes being more prevalent in patients with solid tumors (26% vs 12%, p=0.036). The prevalence of heart failure was predominantly NYHA I and II in solid tumors and NYHA III in hematological cancer (p=0.002) (Table 2). The incidence of coronary artery disease (CAD) was the most common MACE in solid tumors (39% vs 34%), but this was not statistically significant (p=0.04). In hematological cancer, the most frequent MACE was myocardial dysfunction, showing a significant difference (46% vs 24%, p=0.002). Similarly, valvular heart disease (VHD) appeared more frequently in this group (38% vs 20%, p=0.01). The remaining MACEs did not show significant differences, nor did the count of MACEs upon hospital arrival. Conclusion: Myocardial dysfunction and VHD exhibited a higher incidence in hematological cancer compared to solid tumors. Conversely, the incidence of CAD was higher in the solid tumor group; however, similar to the occurrence of other MACEs, there was no significant difference between the two groups. These findings could emphasize the importance of closely monitoring specific cancer types to enhance prevention strategies but still need further analysis to also determine the exact etiologies.

Navigating Gatekeeping Challenges in Pediatric and Young Adult Palliative Oncology and End-of-Life Research.

Participation in research offers families a sense of control and meaning in pediatric cancer care. Gatekeeping limits progress-collaboration is key. #PediatricOncology #PalliativeCare #Research #PallOnc #pedonc #hpm #hapc.

Association of inpatient and outpatient pediatric palliative care with healthcare utilization and end-of-life outcomes in pediatric oncology.

Pediatric palliative care (PPC) is associated with improved end-of-life (EOL) outcomes. Inpatient and outpatient PPC have unique roles during the disease course. Yet, it is unknown whether the location of PPC receipt (inpatient vs. outpatient) is associated with healthcare utilization and EOL outcomes for pediatric and adolescent and young adult oncology patients. A retrospective single-institution chart review of pediatric patients (age 0-28) with cancer who died between January 2015 and December 2022 was performed to compare EOL outcomes and healthcare utilization metrics among inpatient PPC, any outpatient PPC, and non-PPC recipients. Demographics and clinical factors were analyzed by PPC receipt location. Among 450 patients, 292 (64.9%) received PPC (inpatient only 35%, any outpatient 65%). Patients who died without receiving PPC dropped from 69% to 22% following development of an outpatient PPC clinic (p<.001). In the last 6months, 1month, and last week of life, inpatient PPC recipients spent more days admitted to the hospital and intensive care unit (all p<.001), and had more intensive medical interventions performed (p<.01). Outpatient PPC recipients were less likely to receive intravenous (IV) chemotherapy (p<.01) or intubation (p=.05), and more likely to receive hospice, die at home, and have an outpatient do-not-resuscitate order (all p<.001). PPC receipt substantially increased after the creation of an outpatient PPC clinic, suggesting that outpatient PPC is critical in the provision of PPC to children with cancer. Outpatient PPC was associated with fewer hospital days, IV chemotherapy, and intubation at EOL, while increasing hospice enrollment and home death.

Malnutrition risk screening in adult oncology outpatients: An ASPEN systematic review and clinical recommendations.

Malnutrition screening is not widely practiced in outpatient cancer centers. This review aims to determine the validity of malnutrition screening tools and provide recommendations for clinical use. Studies identified by a systematic review assessed the general validity of screening tools in adult oncology outpatients from five databases through 2022. The American Society for Parenteral and Enteral Nutrition (ASPEN) convened a working group of members from the Academy of Nutrition and Dietetics, Academy of Oncology Nurse and Patient Navigators, American Cancer Society, American Society for Clinical Oncology, American Society for Nutrition, American Society for Radiation Oncology, Association of Cancer Care Centers, and Oncology Nursing Society to answer the following questions: (1) should clinicians screen for malnutrition, (2) which malnutrition screening tools are recommended, and (3) what are the clinical applications for malnutrition risk screening in adult oncology outpatients? Twenty of 738 studies met the criteria and were reviewed. Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5), Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening-2002 (NRS-2002; NRS-2002 ≥ 2 and NRS-2002 ≥ 3), NUTRISCORE ≥ 5, and Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF; PG-SGA SF ≥ 7 and PG-SGA SF ≥ 8). Six screening tools are valid for malnutrition risk identification in oncology ambulatory settings and recommended before treatment initiation and regularly thereafter, depending on treatment course. Research is needed to understand to what extent early diagnosis and management of malnutrition improves the clinical care of oncology patients.

A retrospective audit of audiology encounters in patients undergoing Cisplatin treatment at a large Australian tertiary cancer care centre.

To identify the number and timing of audiology encounters for adult oncology patients in a tertiary care setting in Australia. A retrospective case review was completed for 149 patients who received Cisplatin chemotherapy (CT) at a large, publicly funded tertiary hospital in Brisbane, Queensland, Australia between 1st January and 31st December 2019. Patient data was extracted from the Queensland Oncology Repository (QOR) provided by Cancer Alliance Queensland (CAQ). The number of audiology encounters was low overall with a median of 0 and interquartile range (IQR) of 0-1. Of the entire patient cohort, there was a mean of 1.2 encounters with 56% of patients not engaging with audiology. Where audiology did occur, encounters were most likely before or early in the CT treatment period. This study has demonstrated engagement with audiology services for patients undergoing CT treatment was limited with the few audiology engagements occurring before or early in the CT treatment period. Further research is needed to identify the barriers and facilitators to accessing audiological ototoxic monitoring (OtoM) during chemotherapy treatment in hospitals in Australia. Early identification of ototoxic hearing loss offers the opportunity to minimise further exposure to the ototoxic agent, minimise functional and communication impacts for the patient and provide early opportunity for discussion, education and counselling with patients, carers and their treating team. This, in turn, is expected to improve health related quality of life.

Healthy identity development in adolescent and young adult (AYA) oncology: Enhancing family communication to reduce AYAs’ identity distress.

371 Background: Identity development is the process that informs how an individual views oneself and develops a sense of self. A cancer diagnosis during adolescence and young adulthood (AYA; ages 15-39) disrupts AYAs’ identity development and creates identity distress. Identity development is a key developmental task during AYA. It is a recognized psychosocial concern and need for diagnosed AYAs but remains an understudied psychosocial need in AYA oncology care. Identity development can be promoted (or inhibited) in AYAs’ social interactions. AYAs’ communication with parents (often their primary source of support) may function adaptively or maladaptively for AYAs’ identity development. A communication skills intervention for diagnosed AYAs and parents could address communication strategies that promote AYAs’ healthy identity development while buffering identity distress. To capture knowledge that will contribute to a communication skill intervention, this study aimed to identify parent – AYA communication that promotes or inhibits identity formation. Methods: We recruited 14 AYAs to participate in audio-recorded, semi-structured, in-depth interviews. Eligibility criteria for AYAs included: 1) must be diagnosed with any type of cancer during adolescence (aged 15-18) or emerging adulthood (aged 19-29) and 2) be in active treatment or up to 32 months since the end of treatment. Interviews were thematically analyzed using constant comparative method. Results: AYAs’ age ranged from 19-29 ( M =24 years old), and their age of diagnosis ranged from 15-27 years ( M =21 years old). Diagnosed AYAs shared four types of identity disruptions that involved communication with their parents: independence, friendships, sexual orientation/behavior, and long-term goals. They also shared how parents’ communication either promoted identity development or contributed to identity distress. Results indicated that parents’ using parental psychological control in communication contributed to AYAs’ identity distress. AYAs shared parents prioritizing the AYA’s voice and engaging in emotionally supportive communication fostered their identity development. Conclusions: This study captures specific communication approaches and behaviors in parent-AYA communication and its promotion of AYAs’ identity development or contribution to identity distress. Findings demonstrate the importance of developing communication skills training and conversation tools to helps both AYAs and parents learn how to communicate to promote AYAs’ identity development and better overall psychological well-being.

Examining the relationships between pain, activities of daily living, and perceptions of overall health in older adults with breast cancer: Results from a brief geriatric screening.

273 Background: Geriatric assessment has been identified as an essential component to caring for patients with cancer who are over 65 years old. Prior research suggests that physical pain and illness perceptions each impact important health behaviors. This retrospective study utilized a brief geriatric screen to examine the relationships between pain levels, activities of daily living (ADLs), and perceptions of overall health for older adults with breast cancer. Implications for methods to improve the patient experience for this population are considered. Methods: The Senior Adult Oncology Program (SAOP) screening tool was administered to 429 patients age 65 or older at a breast oncology clinic. A total ADL score was computed by summing patient-reported responses to 13 ADL items, such as ability to dress oneself, feed oneself, and remember to take medications. A higher ADL score indicates greater difficulty with these responsibilities. Pain was assessed using a 10-point scale; scores were dichotomized to form a low-pain group (scores 0-4) and high-pain group (scores 5-10). Overall Health was assessed on a 1-10 scale, with higher scores indicating perceptions of greater health. Demographic and medical information was abstracted from patients’ electronic health records. Independent samples t-tests examined differences between the high-pain and low-pain groups in total ADL score and self-assessed Overall Health. Results: The average age of the sample was 76 years old (range = 65-89 years). Approximately half of the sample identified as White (48%); 20% identified as Black. In comparing the high-pain and low-pain groups, the high-pain group reported significantly greater difficulty with ADLs (M score = 3.25, 1.41, respectively; p=.026). Additionally, patients endorsing high pain levels reported significantly worse Overall Health as compared to patients endorsing low levels of pain (M= 7.50, 6.11, respectively; p=.001). Conclusions: Older adults with breast cancer experiencing high levels of pain demonstrated greater difficulty with ADLs and worse perceptions of overall health. It is critical that pain is assessed early and often for older adults with breast cancer. Early identification of high pain levels in this population could allow those in need to receive pharmacological and/or behavioral treatments for pain, which may maintain stability or promote improvement in ADLs and perceptions of one’s health. Incorporating brief pain assessments into future geriatric screening tools could improve the process of aging during and after breast cancer.

Serum Carnitine Concentrations and Cardiac Function in Pediatric, Adolescent and Young Adult Oncology Patients Receiving High-Dose Anthracyclines

OBJECTIVE Anthracycline chemotherapy agents have significant dose-dependent cardiotoxic effects. ­Carnitine, a non-essential amino acid, is involved in long chain fatty acid oxidation, and carnitine deficiency can result in cardiomyopathy and cardiac arrhythmias. If administered concurrently with chemotherapy, carnitine supplementation could be a potential strategy to prevent cardiotoxicity. However, the association between serum carnitine concentrations and anthracycline cardiotoxicity during cancer treatment in the childhood, adolescent, and young adult (CAYA) age range has not been established. METHODS This prospective pilot cohort study characterized changes in serum carnitine concentrations and cardiac function before, during, and approximately 1 year after large-dose anthracycline therapy in newly diagnosed CAYA cancer patients. RESULTS Among 21 patients with a mean cumulative anthracycline dose exposure of 409 mg/m2 of ­doxorubicin equivalents, left ventricular ejection fraction and relative wall thickness decreased, indicating an overall decline in cardiac function. A reversible decrease in serum carnitine concentrations was also observed. A non-statistically significant positive correlation was observed; for every 1 mmol/L decrease in serum carnitine concentration, there was a 0.09% decrease in LVEF (p = 0.2). CONCLUSIONS These findings from this small pilot study suggest that there may be a relationship between serum carnitine concentrations and cardiac function after anthracycline therapy that should be evaluated in larger studies.

O10-1 A single centre experience on adolescent and young adult oncology (AYAO) patient perspectives on fertility preservation

O10-1 A single centre experience on adolescent and young adult oncology (AYAO) patient perspectives on fertility preservation

Exploring Racial Disparities in Awareness and Perceptions of Oncology Clinical Trials: Cross-Sectional Analysis of Baseline Data From the mychoice Study.

Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity. This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process. As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported race was dichotomized into Black/African American and non-Black/African American. As appropriate, 2-tailed t tests and chi-square tests of independence were used to examine differences between groups. Black/African American participants had lower clinical trial knowledge (P=.006), lower health literacy (P<.001), and more medical mistrust (all P values <.05) than non-Black/African American participants. While intentions to participate in a clinical trial, if offered, did not vary between Black/African American and non-Black/African American participants, Black/African American participants indicated lower awareness of clinical trials, fewer benefits of clinical trials, and more uncertainty around clinical trial decision-making (all P values <.05). There were no differences for other variables. Despite no significant differences in intent to participate in a clinical trial if offered and high overall trust in individual health care providers among both groups, beliefs persist about barriers to and benefits of clinical trial participation among Black/African American patients. Findings highlight specific ways that education and resources about clinical trials could be tailored to better suit the informational and decision-making needs and preferences of Black/African American oncology patients.